Improvement of Diffuse Axonal Damage and Sinking Flap Syndrome Post Craneoplasty
Abstract
The trephined, craniotomized, or sunken flap syndrome encompasses neurological manifestations associated with skin flap depression and is distinguished from post-traumatic syndrome by its reversibility with repair treatment of the cranial defect. Coma is not a common form of presentation. We report a case of atypical presentation in a 35-year-old man with a history of decompressive craniectomy, who presented with profound neurological deterioration attributable to trephination syndrome, which reverted after cranioplasty. Cerebrovascular, metabolic, hydrodynamic disorders of the cerebrospinal fluid and hyper dynamism of brain structures are involved in the pathophysiology of the syndrome. The therapeutic gold standard is cranioplasty. The syndrome of the trephined, craniotomized or sunken flap syndrome is commonly referred as neurological manifestations associated to skin flap depression and reversible after craneoplasty, which allows its differentiation from post-traumatic syndrome.